DM Med Management

Question 1

What do Beta Cells Secrete?

Answer 1

Insulin

Question 2

What is Insulin stimulated by?

Answer 2

Hyperglycemia (postprandial)

Question 3

What is the action of Insulin in the body?

Answer 3

1. Promote uptake of glucose into peripheral tissues: Muscle and adipose tissue
2. Suppress Glucagon release
3. Suppress hepatic production of glucose
4. Slows gastric emptying

Question 4

What do Alpha Cells secrete?

Answer 4

Glucagon

Question 5

What is Glucagon stimulated by?

Answer 5

HYPOglycemia (fasting state)

Question 6

What does Glucagon promote in the liver?

Answer 6

1. Glycogenolysis

2. Gluconeogensis

Question 7

What does metabolic Syndrome increase your risk of?

Answer 7

Developing Type 2 DM and CVD

Question 8

Diabetic Retinopathy Tx

Answer 8

Laser photocoagulation

Question 9

Diabetic Neuropathy Tx

Answer 9

1. Pregablin, Gabapentin
2. Duloxetine
3. TCA’s
4. Carbamazepine
5. NSAIDs

Question 10

Diabetic Nephropathy Tx

Answer 10

1. ACE-I or ARB: Initial therapy
2. Diuretic
3. CCB

Question 11

What is the first line test in the diagnosis of Type 2 DM?

Answer 11

Fasting Plasma Glucose

Question 12

Where do you NOT test for blood sugars when using the SGBM?

Answer 12

Fingertips

Question 13

What does self-blood glucose monitoring reflect?

Answer 13

Mediation Effectiveness

Question 14

What does Fasting Blood Sugars measure?

Answer 14

Effectiveness of Basal Insulin or Agents that decrease hepatic gluconeogensis OVERNIGHT= “Leaky Liver”

Question 15

What does Premeal Blood Sugars help calculate?

Answer 15

Bolus Insulin Dose or agents that improve insulin secretion

Question 16

What does Postmeal Blood Sugars measure?

Answer 16

Effectiveness of Bolus Insulin or agents that increase levels of insulin= “Pancreas Poop out”

Question 17

What does Bedtime Blood Sugars help avoid?

Answer 17

Early AM lows from Insulin or Oral agents

Question 18

How often and who should you check blood sugars in Type 2 DM

Answer 18

2x/wk: BEFORE and AFTER meals

Postmeal blood sugar=Most important

Question 19

What are the 5 major concerns when considering choosing a medication in DM?

Answer 19

1. Hypoglycemia
2. Weight Changes
3. CV effects
4. Renal Adjustments
5. FDA Warnings

Question 20

List the FDA approved treatment/meds for obesity

Answer 20

1. Orlistat
2. Lorcaserin
3. Phentermine/Topiramate*
4. Liraglutide* (GLP-1 Agonist)
5. Naltrexone/bupriopion

Question 21

List the low-risk medications in the treatment of Pre-DM

Answer 21

1. Metformin

2. Acarbose

Question 22

What are the ADA HTN recommendations for starting a patient on ONE agent?

Answer 22

BP between 140/90-160/100

Question 23

What are the ADA HTN recommendations for starting a patient on TWO agent?

Answer 23

BP > or equal to 160/100

Question 24

According to ACE, what is the goal BP?

Answer 24

<130/80

Question 25

What are the ACE HTN recommendations for starting DUAL THERAPY

Answer 25

> 150/100

Question 26

According to ACE, what is the A1c goal for patients without concurrent serious illness and @ low hypoglycemic risk?

Answer 26

< or equal to 6.5%

Question 27

According to ACE, what is the A1c goal for patients WITH concurrent serious illness and @ hypoglycemic risk?

Answer 27

> 6.5%

Question 28

What is a ADE of diuretics that you need to make sure you monitor?

Answer 28

Hyperglycemia

Question 29

According to ACE, what A1c level do you consider Monotherapy?

Answer 29

<7.5%

Question 30

List the drugs in order of efficacy for monotherpay

Answer 30

1. Metformin
2. GLP-1
3. SGLT-2I
4. DPP-4
5. TZD

Question 31

According to ACE, what A1c level do you consider Dual therapy?

Answer 31

> or equal to 7.5%

Question 32

What other drug are you considering for dual therapy?

Answer 32

Basal Insulin

Question 33

ACE recommendations for an A1c level of >9%

Answer 33

1. No sx’s: Dual or Triple therapy

2. Sx’s: Insulin +/- Other agents